florida medicaid ehr incentive program...meaningful use eps who have received the payment year one...
TRANSCRIPT
Florida Medicaid EHR
Incentive Program
FQHC and RHC Eligible Professional
Participation Requirements
What?
Health Information Technology
Economic and Clinical Health Act
aka ARRA
aka Stimulus
$2 billion for the creation of state level
Health Information Exchanges (HIE’s)
$17.2 billion for the Medicare and
Medicaid incentive programs
Funding for Regional Extension Centers
GOAL: Ensure that each
person in the United States
has an electronic health
record by 2014
1/18/2012
Why?
Improved communication • between health care providers reducing administrative burdens on the
practitioner and staff.
Better involvement • in health care choices, encouraging patients to take charge of their
information.
Increased quality of care, safety, and reduction in errors • delivering comprehensive patient data for more informed treatment.
Promotion of cost containment • through improved coordination, streamlined information, and less
duplication.
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How?
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GETTING STARTED . . .
Attesting for Adopt,
Implement or Upgrade
1/18/2012
Which Program is Right for Me?
Medicare
Pays up to $44,000 over a five year period (cannot exceed 75% of EPs allowable Part B charges)
Program spans 2011 - 2016
Must meet criteria each year
Payment adjustment beginning 2015
Must meet meaningful use measures in year one
Must participate in consecutive years
Medicaid
Pays up to $63,750 over a five year period
Program spans 2011 through 2021 (must begin by 2016)
Does not have to be consecutive year participation
Adopt, Implement, Upgrade Period for Year One
Meaningful Use in Later Years
No payment penalty
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Participation Chart for Medicaid
CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016
CY 2011 $21,250
CY 2012 $8,500 $21,250
CY 2013 $8,500 $8,500 $21,250
CY 2014 $8,500 $8,500 $8,500 $21,250
CY 2015 $8,500 $8,500 $8,500 $8,500 $21,250
CY 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250
CY 2017 $8,500 $8,500 $8,500 $8,500 $8,500
CY 2018 $8,500 $8,500 $8,500 $8,500
CY 2019 $8,500 $8,500 $8,500
CY 2020 $8,500 $8,500
CY 2021 $8,500
TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750
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Understanding Timeframes
1. Volume timeframe • calendar year (aka Program Year) prior to Payment Year
• representative, consecutive 90-day period
-DISTINCT FROM-
2. Adopt, Implement or Upgrade timeframe • phase of Certified Electronic Health Record
-DISTINCT FROM-
3. Meaningful Use timeframe • first year – 90 day period of actually using the system
• second year – 365 day period of utilization including reporting
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Am I Eligible?
Must Be An Eligible Provider Type
-and-
Must Meet Patient Volume Requirements
-and-
Must Have A Certified Electronic Health Record
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Provider Eligibility Provider Type Requirements
Physicians – all types
Advanced Registered Nurse Practitioners (ARNPs)
Certified Nurse-Midwives
Dentists
Physicians Assistants (PA)* *Must be working in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) led by a PA and “Attestation for
Physician Assistant Led” form must be completed
Additional Requirements • active status
• licensed in all states from which volume is reported
• not have outstanding state or federal sanctions
• not have 90% or more encounters in a year in a hospital or emergency room setting
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Physician Assistants How to determine if the site of practice is PA led:
When a PA is the primary provider in a clinic (for example, when there is a part-time physician and full-time PA, the PA would be considered as the primary provider);
When a PA is a clinical or medical director at a clinical site of practice; or
When a PA is an owner of an RHC.
Must complete the “Attestation for Physician Assistant Led” form
11/14/2011
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Attestation for Physician Assistant Led
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Defining Volume
EPs must have 30% Medicaid volume
• Based on a representative, consecutive 90 day period
within the previous calendar year
Pediatricians can meet volume requirements at 20%
• Resulting in a 2/3rds payment
Definition of volume
• An encounter provided to a single person on a single day
for which Medicaid paid all or some part
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Volume Includes HMO/MediPass/Managed Care
Encounters from another Medicaid
program (e.g. Alabama, Georgia, etc.)
If you practice in an FQHC or RHC at
least 50% of time -- needy individuals can
be included
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Needy Individuals Defined as:
Received medical assistance from Medicaid or the Children's
Health Insurance Program. (or a Medicaid or CHIP
demonstration project approved under section 1115 of the Act).
Were furnished uncompensated care by the provider.
Were furnished services at either no cost or reduced cost based
on a sliding scale determined by the individuals' ability to pay.
11/14/2011 1/18/2012
Volume Methodologies EPs can calculate patient volume in one of three ways:
1. Individual Volume: EP uses individual (private practice) Medicaid encounters
Total Medicaid Volume
Total Individual Volume
2. Group Proxy Volume: EP uses group Medicaid encounters
Total Group Medicaid Volume
Total Group Volume
3. Individual Volume when affiliated with a group: EP using his individual
encounters from the group but all members must use this method
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Am I A Group?
Under the Medicaid EHR Incentive Program, how you bill for
Medicaid services determines your group status. In most
instances this will be your Medicaid Group ID.
Have questions, give us a call . . .
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Group as an FQHC or RHC Volume Can Be Determined at the:
Location/Clinic/Site/Satellite Level -OR-
Parent Level
Group proxy must be appropriate as a patient volume
methodology calculation for the EP
Only encounters associated with that group may be used and
must include ALL group encounters
All EPs using that group’s volume must render services to
Medicaid patients
11/14/2011 1/18/2012
New Group Members
Can use group volume if: Are a member of the group at the time of attestation
Have provided at least one paid Medicaid service
from the beginning of the volume period to date of
attestation
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ARNP Volume Determination
ARNPs can apply using individual volume
group volume
their individual volume from the group
or their supervising physician’s individual volume
from the group for services the ARNP rendered.
Refer to Program Update December 15th for application details
1/18/2012
Supporting Reported Volume
To support the volume reported, include:
Summary documentation from the Practice Management System
Encounters by Payer and Total Encounters
Patient Encounter Tool (optional)
Details on how volume was calculated
Details on sources and application of data
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What is Your Phase?
Adoption
Implementation
Upgrade
Documentation Requirements:
• must reference your certified EHR technology (e.g. system name
and version)
• must be a business record of the purchase or upgrade that states
financial obligation and timeframe (e.g. receipt or executed contract)
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Documentation Examples
Other examples can include:
Invoice that has been paid
Executed upgrade agreements for which a cost and timeframe
are stated
A vendor letter is acceptable only if it contains the provider
name, the system name and version, the financial obligation, a
timeframe for adopt, implementation or upgrade, and is signed
by the vendor. The vendor letter in essence becomes a legally
binding document such as a contract or agreement
Screen shots of the system are not acceptable
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Free Systems
If documentation requirements cannot be met:
A copy of the first page of the license agreement
A screen shot indicating the software’s name and version
A copy of the home screen that displays at a minimum the
providers name and the name of the free software (usually a
header at the top of each screen)
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System Certification?
EPs have to register system using the “CHPL” website:
http://onc-chpl.force.com/ehrcert
(CHPL = Certified HIT Product List)
If you do not have a complete system, the EP is responsible for ensuring all modules meet requirements
• Upon registration a certification code is issued
• This code is required for your application
• You will also need a screen shot indicating the certification number
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System Certification?
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Payment
PAYEE
Designated during R&A process and changes must be done at the R&A
Tax ID (TIN) indicated as screen header in application
Must be an active FMMIS provider
Must be a contractual relationship between the EP and the Payee
ISSUANCE
Included in Regular Payment Cycle Schedule
Included in 1099 Reporting
Based on existing FMMIS information including EFT data.
Allow 30 business days after approval for submission to financial cycle
• Receive an email stating that payment is being processed
1/18/2012
Documents to be Uploaded 1. Practice Management System (PMS) summary report for the 90 day period
supporting your reported numerator and denominator. Needs to contain EP and /or Practice Name.
2. Documentation that supports the adoption, implementation or upgrade of the certified technology
3. Screen shot from the Certification (CHPL) Website identifying your system and assigned certification number.
OPTIONAL: “Patient Encounter Tool” excel spreadsheet to further explain volume determination
Other
If a you are a Physician Assistant you must also include the “Attestation for Physician Assistant Led” form available on the website
If you are an ARNP or new group member, you must include a copy of a medical record indicating services rendered
These documents will be uploaded at Step Seven of the application
All documents must be a PDF version
The individual document cannot exceed 2MB BUT no limit to the number of documents that can be added
1/18/2012
Program Updates Volume Timeframe
Grace Period for using 2010 volume until March 1, 2012
(applications have to be processed by 3/31/2012)
Applications using 2011 volume may experience a delay in
processing
Meaningful Use
EPs who have received the Payment Year One incentive for
AIU can start their 90 day period for the meaningful use
attestation beginning January 1, 2012
EPs may apply for a meaningful use incentive payment
beginning April 1, 2012 (anticipated)
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General Application Tips
You must complete each section before progressing to the next
Save at each step
“TIP Sheets” and a “Users Manual” are available on the
website
Turn off your Pop-Up Blocker
Have a staff member who you can refer to about technical
aspects on the application (Office Manager, etc.)
You can stop and continue the application if you need more
time
REVIEW, REVIEW, REVIEW
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Getting Started - Federal CMS Registration and Attestation (R&A)
Locate your National Provider Identifier (NPI) and Tax Identification
Number (TIN). If you don’t have an NPI, visit NPPES to apply for one.
Have a NPPES web user account. If you do not have one, visit NPPES.
Register at the CMS EHR Incentive Program Registration site using the log-
in credentials for your NPPES web user account and select Florida for your
payment state.
Tips
There is a “Quick Link” within your individual web portal to the application
Within three days of successful registration at the R&A your application
is populated with your registration information
An email is sent once the application is active
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Web Portal Page
Individual NPI Login
Password Reset: 1-800-286-7799
option 5
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Getting Started - State If you have successfully registered with the R&A AND your
information matches Medicaid’s provider file (NPI and Tax
ID) your application status will say Not Started
If your R&A registration did not match your provider file,
your application will say Not Registered at R&A
• TAX ID and NPI mismatch
• Not an Active Provider
• Outstanding Sanctions
• No NPI in the Provider Enrollment File
If you have not registered with the R&A, your application
status will say Not Registered at R&A
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Section by Section Getting Started R&A/Contract Info
Eligibility Patient Volumes
Attestation Review
Submit
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Beginning Section Screen
10/18/2011 1/18/2012
Completed Section Screen
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R&A/Contact Info Tab
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R&A/Contact Info Tab
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Eligibility Tab – Certification Number
9/13/2011
12 - 15 digits with No Spaces or Dashes
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Patient Volumes Tab
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Patient Volumes Tab – 90 Day Period
9/13/2011 1/18/2012
Patient Volumes Tab - Location
9/13/2011 1/18/2012
Individual Volume - FQHC/RHC
9/13/2011 1/18/2012
Group Volume - FQHC/RHC
9/13/2011 1/18/2012
Patient Volumes Tab - Confirmation
9/13/2011 1/18/2012
Attestation Tab
9/13/2011 1/18/2012
Attestation Tab
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Review Tab
9/13/2011 1/18/2012
Review Tab – Page 4
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Submit
9/13/2011 1/18/2012
Submit – as a preparer
9/13/2011 1/18/2012
Submit
9/13/2011 1/18/2012
Submit – Upload Documents
9/13/2011 1/18/2012
Now That You Have Submitted
You will receive an email confirming submission
Pre-payment validation
Re-verification with the R&A
Submission to financial cycle
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What the Payment Looks Like
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Questions? Email:
Phone:
EHR Incentive Program Call Center : 1 (855) 231- 5472
Website:
www.ahca.myflorida.com/medicaid/ehr
Reference materials:
“Frequently Asked Questions” on the website
1/18/2012
Health Information Exchange
Direct Secure
Messaging (DSM) is a
secure e-mail system
that allows participants
to send encrypted
health information to
other participants.
Patient Look-Up (PLU)
allows clinicians to
access patient records
from participating
networks organization or
other sources.
www.Florida-HIE.net
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Regional Extension Centers
Determine eligibility for the EHR incentive programs
and help providers navigate the registration process
Select the most cost-effective EHR for your practice
Plan a successful EHR implementation
Enhance administrative and clinical workflows
Assess and meet training needs
Achieve meaningful use of HIT
Maximize HIT incentive payments
Connect for HIE Services
Improve the value and quality of patient care
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Regional Extension Centers
Phone: (727) 573-2422 ext. 300 Email: [email protected] www.AdvanceHealthIT.org Phone: (813) 974-7742 Email: [email protected] www.PaperFreeFlorida.org Phone: (407) 882-0727 Email: [email protected] www.ucf-rec.org Phone: 1-866-628-9193 Email:[email protected] www.southfloridarec.org
1/18/2012
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1/18/2012